Fundamentals of Nursing

Page 1: Introduction

  • FUNDAMENTALS OF NURSING SCRUB A NOTES

Page 2: Table of Contents

  • Major Topics Covered:

    • Nursing theory

    • The professional nurse

    • Evidence-based practice

    • Nursing process

    • Nursing ethics

    • Health care delivery

    • Health promotion

    • Population health

    • Cultural competence

    • Caring and communication

    • Patient safety

    • Infection prevention

    • Vital signs

    • Head-to-toe assessment

    • Medication administration

    • Medication dosage calculation

    • Pain management

    • Activity, mobility, and exercise

    • Oxygenation and airway maintenance

    • Nutrition

    • Electrolyte imbalances

    • Skin and wound care

    • Hygiene

    • Urinary elimination

    • Bowel elimination

    • Crisis and disaster

    • Legal considerations

    • Documentation

Page 3: Levels of Nursing Proficiency

  • Categories of Nursing Proficiency:

    1. Novice:

      • Student nurse or RN in a new setting with no previous experience.

    2. Advanced Beginner:

      • RN with some experience in a clinical setting.

    3. Competent:

      • RN with 2-3 years experience in the same clinical setting.

    4. Proficient:

      • RN with over 2-3 years experience in the same clinical setting.

    5. Expert:

      • Lengthy experience in a clinical setting.

  • Nursing Process Steps:

    • Assessment

    • Diagnosis

    • Outcomes Identification

    • Planning

    • Implementation

    • Evaluation

  • Responsibilities of a Nurse:

    • Accountability

    • Autonomy

    • Advocate

    • Caregiver

    • Communicator

    • Educator

    • Manager

  • Nursing Code of Ethics:

    • Guides nurses in making ethical decisions in their practice.

Page 4: Nursing Theories

  • Key Nursing Theories:

    • Nightingales Environmental Theory:

      • Manipulate the environment to enhance patient health and recovery.

      • Control factors: Light, Hygiene, Nutrition, Noise, Ventilation.

    • Peplaus Interpersonal Theory:

      • Focuses on nurse-patient relationships and communication.

    • Orems Self-Care Deficit Theory:

      • Promotes patient participation in self-care for better outcomes.

    • Leiningers Culture Care Theory:

      • Importance of incorporating culture in care plans.

Page 5: Evidence-Based Practice (EBP)

  • Definition:

    • A step-by-step process promoting best healthcare practices for optimal outcomes.

  • Components of EBP:

    • Relevant, critically appraised evidence, nurse's experience, patient's preferences.

  • 7 Steps of Evidence-Based Practice:

    1. Cultivate a spirit of inquiry.

    2. Ask a clinical question in “PICOT” format.

    3. Collect the best evidence.

    4. Critically appraise the evidence.

    5. Integrate evidence with clinical expertise and patient preferences.

    6. Evaluate outcomes of practice decisions.

    7. Share outcomes.

  • PICOT Framework:

    • P: Patient population

    • I: Intervention of interest

    • C: Comparison of interest

    • O: Desired outcome

    • T: Timeframe

  • Hierarchy of Evidence:

    • Opinion of experts, case studies, controlled trials, reviews of RCTs, etc.

Page 6: Nursing Process Overview

  • Steps of Nursing Process:

    1. Assessment:

      • Collect subjective and objective data.

    2. Diagnosis:

      • Formulate nursing diagnoses based on assessment data.

    3. Outcomes Identification:

      • Establish measurable goals.

    4. Planning:

      • Develop a comprehensive care plan.

    5. Implementation:

      • Execute nursing interventions.

    6. Evaluation:

      • Review patient outcomes and adjust care as necessary.

  • Materials for Assessment:

    • Patient history, observation, interviews, exams, diagnostic reports.

Page 7: Nursing Ethics

  • Key Ethical Principles:

    1. Autonomy:

      • Right to make decisions.

    2. Justice:

      • Fair and equal treatment.

    3. Beneficence:

      • Best interest of the patient.

    4. Non-maleficence:

      • Do no harm.

    5. Fidelity:

      • Keeping promises.

    6. Veracity:

      • Truthfulness in communication.

  • Solving Ethical Dilemmas:

    1. Identify the dilemma.

    2. Gather information.

    3. Reflect on personal values.

    4. Analyze options.

    5. Evaluate outcomes.

Page 8: Health Care Delivery

  • Healthcare Participants:

    • Consumers, providers, unlicensed personnel.

  • Types of Healthcare Settings:

    • Hospitals, urgent care, community health, etc.

  • Healthcare Plans:

    • Medicare, Medicaid, private insurance, etc.

  • Levels of Care:

    • Preventive, primary, secondary, tertiary, and restorative care.

  • Issues in Healthcare Delivery:

    • Nursing shortage, competency, patient satisfaction, etc.

Page 9: Health Promotion

  • Internal & External Variables:

    • Age, gender, culture, environment, etc.

  • Levels of Prevention:

    1. Primary Prevention:

      • Health promotion and disease prevention.

    2. Secondary Prevention:

      • Early interventions and screenings.

    3. Tertiary Prevention:

      • Rehabilitation and management of symptoms.

Page 10: Social Determinants of Health

  • Definition:

    • Factors influencing individual health states.

  • Vulnerable Populations:

    • People in poverty, older adults, homeless individuals, etc.

  • Community Roles:

    • Caregiver, educator, counselor, etc.

Page 11: Cultural Competency

  • Definition:

    • Ability to provide care that respects cultural beliefs and practices.

  • Components of Culturally Congruent Care:

    • Awareness, knowledge, skills, encounters, and desire.

Page 12: Caring and Communication

  • Aspects of Caring:

    • Being present, listening, touch, symptom relief, family care.

  • Types of Communication:

    • Intrapersonal, interpersonal, small group, public, electronic.

  • Therapeutic Techniques:

    • Active listening, body language, validation, paraphrasing.

Page 13: Patient Safety

  • Basic Physiological Safety Needs:

    • Oxygen, nutrition, temperature.

  • Safety Risks by Age:

    • Infants to older adults.

  • Fall Prevention Strategies:

    • Risk assessments, proper positioning, environmental modifications.

Page 14: Infection Prevention

  • Types of Pathogens:

    • Bacteria, viruses, fungi, pathogens.

  • Personal Protective Equipment (PPE):

    • Guidelines for donning and removal.

  • Chain of Infection:

    • Agents, reservoirs, portals of exit, transmission.

Page 15: Vital Signs

  • Types of Vital Signs to Monitor:

    • Temperature, respiration, pulse oximetry, pulse, blood pressure.

  • Importance of Accurate Measurements:

    • Use proper techniques based on patient condition.

Page 16: Head-To-Toe Assessment

  • Key Assessment Areas:

    • Physical appearance, vital signs, assessment of major body systems.

Page 17: Pharmacokinetics

  • Four Phases:

    • Absorption, distribution, metabolism, excretion.

  • Types of Medication Orders:

    • Routine, prn, one-time, stat, now orders.

  • Rights of Medication Administration:

    • Right medication, dose, route, patient, time, documentation.

Page 18: Dosage Calculation

  • Conversions:

    • Weight and volume conversions for medication dosing.

  • Techniques for Calculating Doses:

    • Solid dosages, liquid dosages, weight-based.

Page 19: Pain Management

  • Physiology of Pain:

    • Stages of pain perception and response.

  • Types of Pain:

    • Chronic, acute, nociceptive, neuropathic.

  • Pain Management Strategies:

    • Non-pharmacological and pharmacological approaches.

Page 20: Activity and Mobility

  • Importance of Activity:

    • Enhances body system functioning.

  • Assessment of Mobility:

    • Assess posture and pain during activity.

  • Assistive Devices:

    • Walkers, canes, crutches, positioning techniques.

Page 21: Oxygenation

  • Factors Affecting Oxygenation:

    • Decreased capacity, changes in respiratory function, lifestyle impacts.

  • Oxygen Delivery Methods:

    • Low-flow and high-flow systems, incentive spirometry, breathing techniques.

Page 22: Nutrition

  • Nutritional Units and Sources:

    • Carbohydrates, proteins, fats, vitamins, minerals.

  • Factors Influencing Nutrition:

    • Socioeconomic status, age, appetite.

Page 23: Electrolyte Imbalances

  • Common Electrolyte Disorders:

    • Hyponatremia, hypernatremia, hypokalemia, hyperkalemia, etc.

  • Symptoms and Causes:

    • Discuss causes and specific symptoms of each imbalance.

Page 24: Skin and Wound Care

  • Stages of Wound Healing:

    1. Inflammatory Phase

    2. Proliferative Phase

    3. Maturation Phase

  • Assessment of Wounds and Healing Types:

    • Primary, secondary, tertiary intention.

Page 25: Hygiene

  • Factors Influencing Hygiene:

    • Social, cultural, personal preferences.

  • Types of Baths and Techniques:

    • Full bed baths, oral hygiene, hair care, nail care, etc.

Page 26: Urinary Elimination

  • Factors Affecting Urinary Elimination:

    • Age, pregnancy, diet, immobility.

  • Specimen Collection Techniques:

    • Routine urinalysis, clean-catch, sterile specimens.

Page 27: Bowel Elimination

  • Factors Affecting Bowel Function:

    • Age, diet, physical activity.

  • Constipation and Diarrhea Assessment:

    • Causes and treatments for each condition.

Page 28: Crisis and Disaster Management

  • Types of Emergencies and Triage:

    • Internal and external emergencies, triage classifications.

  • Fire Safety Procedure:

    • RACE protocol to manage fires.

Page 29: Legal Considerations

  • Legal Regulations in Nursing:

    • Nurse Practice Acts, types of torts.

  • Informed Consent and Advance Directives:

    • Importance and procedures for informed consent.

Page 30: Documentation

  • Purpose of Medical Records:

    • Communication, quality improvement, legal documentation.

  • Guidelines for Effective Documentation:

    • Must be factual, accurate, complete, current, and organized.